Publications (13)22.05 Total impact
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Article: Tiny aneurysms treated with single coil: Morphological comparison between bare platinum coil and matrix coil.
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ABSTRACT: OBJECTIVE: We analyzed the angiographic results of tiny aneurysms treated with various kinds of single coils including polyglycolic-polylactic acid (PGLA)-coated coils. METHODS: Forty aneurysms with diameters measuring less than 4mm were treated with a single bare platinum, Matrix1, or Matrix2 coil. Most of the aneurysms were treated with a 2mm diameter coil, except for seven treated with a 3mm coil, four treated with a 2.5mm coil, and two treated with a 1.5mm coil. The mean length of the coils was 3.6cm. RESULTS: With mean packing ratios of 21.2%, 19.7%, and 22.8%, we achieved initial complete occlusion rates of 9.5% with the platinum coil, 28.6% with the Matrix1 coil, and 25.0% with the Matrix2 coil. The mean follow-up interval was 23.1 months and the complete occlusion rate improved up to 47.6% for the platinum coil, 57.1% for the Matrix1 coil, and 83.3%for the Matrix2 coil. Compared to the Platinum group, the Matrix2 group showed a greater tendency toward more complete occlusion on the follow-up images. Regardless of coil type, the aneurysms treated with a stent-assisted technique showed better complete occlusion rates (50.0% vs. 90.0%, p=0.03). CONCLUSIONS: The tiny aneurysms treated with a single Matrix2 coil tended to have better follow-up angiographic results than the aneurysms treated with a single platinum coil. Furthermore, the use of a stent-assisted technique and increasing the packing density also positively affected the healing of these tiny aneurysms.Clinical neurology and neurosurgery 06/2012; · 1.30 Impact Factor -
Article: Grading of intracerebral hemorrhage in ruptured middle cerebral artery aneurysms.
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ABSTRACT: To propose grading of intracerebral hemorrhage (ICH) in ruptured middle cerebral artery (MCA) aneurysms, which helps to predict the prognosis more accurately. From August 2005 to December 2010, 27 cases of emergent hematoma evacuation and aneurysm clipping for MCA aneurysms were done in the author's clinic. Three variables were considered in grading the ICH, which were 1) hematoma volume, 2) diffuse subarachnoid hemorrhage (SAH) that extends to the contralateral sylvian cistern, and 3) the presence of midline shifting from computed tomography findings. For hematoma volume of greater than 25 mL, we assigned 2 points whereas 1 point for less than 25 cc. We also assigned 1 point for the presence of diffuse SAH whereas 0 point for the absence of it. Then, 1 point was assigned for midline shifting of greater than 5 mm whereas 0 point for less than 5 mm. According to the grading system, the numbers of patients from grade 1 to 4 were 4, 6, 8 and 9 respectively and 5, 7, 8, 4 and 3 patients belonged to Glasgow Outcome Scale (GOS) 5 to 1 respectively. It was found that the patients with higher GOS had lower ICH grade which were confirmed to be statistically significant (p<0.01). Preoperative Hunt and Hess grade and absence of midline shifting were the factors to predict favorable outcome. The ICH grading system composed of above three variables was helpful in predicting the patient's outcome more accurately.Journal of Korean Neurosurgical Society 05/2012; 51(5):268-71. · 0.60 Impact Factor -
Article: Imaging parameters of high grade gliomas in relation to the MGMT promoter methylation status: the CT, diffusion tensor imaging, and perfusion MR imaging.
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ABSTRACT: We hypothesized that methyl-guanine methyl transferase (MGMT) promoter methylation status, a predictor of the chemosensitivity for high grade gliomas (HGGs), may be associated with computed tomography (CT)/magnetic resonance (MR) imaging variables. Out of 38 consecutive patients with HGGs, 24 patients whose MGMT promoter methylation status was available [12 men and 12 women; median age, 49 years; age range, 22-79 years; WHO grade III (n = 7), WHO grade IV (n = 17)] were enrolled retrospectively. CT attenuation, apparent diffusion coefficient (ADC), fractional anisotropy (FA), and relative cerebral blood volume (rCBV) were measured for enhancing tumors. Qualitative imaging features were also analyzed. Mann-Whitney and Fisher's exact tests were used to evaluate relationships between MGMT promoter methylation status and imaging variables. Maximum CT attenuation was significantly lower in the methylated MGMT promoter group than that in the unmethylated MGMT promoter group (30.3 ± 9.5 HU versus 39.2 ± 4.7 HU, respectively, p = 0.009). While ADC values tended to be higher in the methylated group than in the unmethylated group (p = 0.055), ADC ratio was significantly higher, and the FA and FA ratios were significantly lower in the methylated group than in the unmethylated group (p = 0.032, p = 0.006 and p = 0.007, respectively). In contrast, rCBV ratio did not differ between the two groups (p = 0.380). Regarding imaging features, only ill-defined margin was seen more frequently in the methylated group than in the unmethylated group (45.5% versus 7.7%, respectively, p = 0.048). Preoperative imaging can predict MGMT promoter methylation status, which is of paramount importance for predicting treatment response to chemotherapy with an alkylating agent.Neuroradiology 08/2011; 54(6):555-63. · 2.82 Impact Factor -
Article: Endovascular coil embolization of very small intracranial aneurysms.
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ABSTRACT: Endovascular coil embolization of very small (maximum dome diameter ≤3 mm) aneurysms is controversial because of a high risk for procedural rupture and technical difficulty. We report clinical and angiographic results of coil embolization of these aneurysms. From August 2005 through July 2009, 43 very small aneurysms (23 ruptured, 20 unruptured) in 38 patients (12 males, 26 females; mean age, 53 years) were embolized with detachable coils. Of those 38 patients, 24 (63%) presented with subarachnoid hemorrhage (SAH) from a very small aneurysm (n = 23) or another aneurysm (n = 1). We assessed initial angiographic results, procedural complications, and clinical condition with initial Hunt and Hess grade (HH) and Glasgow outcome scale (GOS) at discharge. Follow-up results were evaluated with conventional angiography and/or magnetic resonance angiography (MRA). Initial aneurysmal occlusion was total in 16 (37%), subtotal in 22 (51%), and partial in five (12%) aneurysms. There were five incidents of thrombosis (12%) and one procedural rupture (2%), but there was no definite adverse effect on clinical outcome. Of 24 patients with SAH, ten patients (42%) were in poor condition (HH 3 or 4) at admission. Seventeen of 24 patients (71%) had good or excellent outcome (GOS ≥4) at discharge. A 6-month or more follow-up angiography and/or MRA was available in 33 (11 total and 20 subtotal and 2 partial in initial occlusion) aneurysms (77%) in 28 patients and revealed stable occlusion in 20 aneurysms (61%), progressive total occlusion in 10 (30%), minor recanalization in 2 (6%), and major recanalization in 1 (3%). Coil embolization of very small aneurysms may be technically feasible with favorable clinical/angiographic outcomes and relatively low recanalization rate during 6 months or more follow-up period.Neuroradiology 05/2011; 53(5):349-57. · 2.82 Impact Factor -
Article: Delayed fatal cerebellar hemorrhage caused by hemangioblastoma after successful radiosurgical treatment.
Acta Neurochirurgica 09/2010; 152(9):1625-7; discussion 1627. · 1.52 Impact Factor -
Article: Fluoroscopy and sonographic guided injection of obliquus capitis inferior muscle in an intractable occipital neuralgia.
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ABSTRACT: Occipital neuralgia is a form of headache that involves the posterior occiput in the greater or lesser occipital nerve distribution. Pain can be severe and persistent with conservative treatment. We present a case of intractable occipital neuralgia that conventional therapeutic modalities failed to ameliorate. We speculate that, in this case, the cause of headache could be the greater occipital nerve entrapment by the obliquus capitis inferior muscle. After steroid and local anesthetic injection into obliquus capitis inferior muscles under fluoroscopic and sonographic guidance, the visual analogue scale was decreased from 9-10/10 to 1-2/10 for 2-3 weeks. The patient eventually got both greater occipital neurectomy and partial resection of obliquus capitis inferior muscles due to the short term effect of the injection. The successful steroid and local anesthetic injection for this occipital neuralgia shows that the refractory headache was caused by entrapment of greater occipital nerves by obliquus capitis inferior muscles.The Korean journal of pain 03/2010; 23(1):82-7. -
Article: A case of Moyamoya disease in a girl with thyrotoxicosis.
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ABSTRACT: Moyamoya disease is a cerebrovascular disorder of unknown cause, characterized by slowly progressive bilateral stenosis or occlusion of the internal carotid arteries and produces collateral vessels. Moyamoya syndrome has rarely been reported in association with Graves' disease, especially in children. Several reports suggest that a cerebral infarction might have occurred in patients with clinical and laboratory evidence of hyperthyroid function. We report a case of Moyamoya disease in a girl with Down syndrome and thyrotoxicosis, and we review the relevant literature. To our best knowledge, this is the first report of Moyamoya disease associated with thyrotoxicosis in a young person in Korea.Yonsei medical journal 09/2009; 50(4):594-8. · 0.77 Impact Factor -
Article: Traumatic entrapment of the vertebrobasilar junction due to a longitudinal clival fracture: a case report.
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ABSTRACT: Vertebrobasilar junction entrapment due to a clivus fracture is a rare clinical observation. The present case report describes a 54-yr-old man who sustained a major craniofacial injury. The patient displayed a stuporous mental state (Glasgow Coma Scale [GCS]=8) and left hemiparesis (Grade 3). The initial computed tomography (CT) scan revealed a right subdural hemorrhage in the frontotemporal region, with a midline shift and longitudinal clival fracture. A decompressive craniectomy with removal of the hematoma was performed. Two days after surgery, a follow-up CT scan showed cerebellar and brain stem infarction, and a CT angiogram revealed occlusion of the left vertebral artery and entrapment of vertebrobasilar junction by the clival fracture. A decompressive suboccipital craniectomy was performed and the patient gradually recovered. This appears to be a rare case of traumatic vertebrobasilar junction entrapment due to a longitudinal clival fracture, including a cerebellar infarction caused by a left vertebral artery occlusion. A literature review is provided.Journal of Korean Medical Science 09/2008; 23(4):747-51. · 0.99 Impact Factor -
Article: Infectious aneurysmal rupture presenting as massive intracerebral hemorrhage in a preterm baby.
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ABSTRACT: Infectious intracranial aneurysms in infantile period are very rare, and there is no report of infectious intracranial aneurysm in preterm infant A 43-day-old female infant, delivered at 29 weeks of gestation, presented with massive intracranial hemorrhage. Eighteen days after diagnoses of necrotizing enterocolitis, sepsis, and meningitis, the baby became lethargic with rigid left limbs. Imaging studies revealed a large hematoma in the right temporoparietal region and adjacent lateral ventricle. During removal of fresh hematoma, an actively bleeding nodular mass, contiguous with the distal middle cerebral artery branch, was found and excised from the parent vessel. Pathologic examination revealed a ruptured infectious intracranial aneurysm. After surgery, her neurologic status improved and she was doing well at 12 months' follow-up with mild spastic hemiparesis. To our knowledge, this is the first reported case of infectious intracranial aneurysm in the preterm infant, which was successfully treated with hematoma evacuation and resection of the aneurysm.Child s Nervous System 03/2008; 24(2):265-8. · 1.54 Impact Factor -
Article: MR angiographic evaluation is limited in intracranial aneurysms embolized with Nexus coils.
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ABSTRACT: Nexus coils are a type of bioactive coil used to embolize intracranial aneurysms. The purpose of this study was to test the feasibility of the noninvasive follow-up of aneurysms treated with Nexus coils by means of magnetic resonance angiography (MRA). Three-dimensional (3D) time-of-flight (TOF) MRA images of patients treated with Nexus coils (the Nexus coil group) or bare platinum coils (the control group) were compared for the severity and frequency of artifacts. The reviewers were unaware of the coil types used. In the Nexus coil group, 17 MRA examinations were performed in 14 patients harboring 15 aneurysms treated with Nexus coils using 3-T (n = 11) and 1.5-T (n = 6) MR units. The findings of these examinations were compared to those of 28 MRA studies conducted on 24 control patients (bare platinum coils). Conventional angiograms, maximum intensity projections, and source data of 3D-TOF MRA were reviewed in terms of residual flow within aneurysms and parent arterial patencies. The qualities of the MRA images were rated from grade 0 (no significant signal loss) to grade 2 (complete segmental signal loss of the parent artery). The normalized ratio, defined as the diameter of signal loss on MRA axial source images (in mm) divided by that of coil mass on plain radiographs (in mm), was calculated to compare the sizes of coil-related artifacts in the two groups. The quality of the MRA image for the Nexus coil group was significantly poorer than that for the control group (p < 0.0001) due to signal loss caused by the presence of artifacts in the former. In particular, the interpretation of aneurysmal status was impossible in all cases of coiled aneurysms due to segmental signal loss. The sizes of the MRA artifacts were also significantly larger in the Nexus coil group (normalized ratio 1.61 +/- 0.22 vs. 1.15 +/- 0.20; p < 0.0001). Follow-up evaluations by 3D-TOF MRA of aneurysms treated with Nexus coils are severely limited.Neuroradiology 02/2008; 50(2):171-8. · 2.82 Impact Factor -
Article: Primary intraosseous malignant fibrous histiocytoma of the skull: a case report.
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ABSTRACT: Malignant fibrous histiocytoma (MFH) is a rare primary neoplasm that constitutes less than 1% of the malignant tumors of bone, and involvement of the skull is very rare. We present a case of malignant fibrous histiocytoma of the skull, presenting an intraosseous lesion in a 43-yr-old woman. She had a rapidly growing, tender mass in the right parietal region. A plain radiograph showed an osteolytic lesion of the right parietal bone. Magnetic resonance imaging revealed that the lesion showed heterogeneous low signal intensity on T1-weighted images and slightly high signal intensity on T2-weighted images. No evidence of an extraosseous extension to the adjacent dura and soft tissue was found, and a wide excision of the parietal bone was performed. Histologically, the tumor was a typical MFH displaying pleomorphic spindle cells in a storiform pattern. The results of immunohistochemical stainings revealed that the tumor cells were positive for vimentin, alpha-1-antitrypsin, and p53, and negative for smooth muscle actin, S100 protein, desmin, and MyoD1. Three months later, a mainly cystic, recurrent mass was developed at the previously operated site. Before the resection, we first performed the percutaneous aspiration cytology, revealing diagnostic multinucleated pleomorphic cells. Thereafter, she had to receive repetitive resections of recurrent or residual lesions, and she died of postoperative meningoencephalitis two years after the first operation.Journal of Korean Medical Science 09/2003; 18(4):609-13. · 0.99 Impact Factor -
Article: Technical problems associated with new designs of Guglielmi detachable coils.
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ABSTRACT: Recently, we experienced several technical problems that were directly related to new designs of Guglielmi detachable coils (GDCs). We herein present cases involving those problems and propose probable causes. We reviewed the clinical and angiographic data of 269 consecutive patients with intracranial aneurysms who had been treated with GDCs between May 1996 and October 2001. We focused on newly encountered technical problems: spontaneous premature coil detachment, backward slipping of the coil into the microcatheter lumen after detachment, and undesirable detachment of the coils at the parent artery. The occurrence and clinical consequences of the problems were investigated before and after the introduction of a new GDC (SynerG) design. Additionally, to confirm the potential causal relationship, in vitro observations and simulation tests were performed. Of the 269 patients, 69 underwent embolization between March and October of 2001. Among those, we encountered technical problems in 10 (14.5%) cases. The overall number of events was 12, including spontaneous detachment (n = 5), backward slipping of the coil into the microcatheter lumen after detachment (n = 4), and undesirable coil detachment with a segment of the coil remaining at the parent artery (n = 3). No similar problems occurred among the 200 patients treated during the period between May 1996 and February 2001, when the new design coil had not yet been introduced. In vitro observations suggested that the long and stiff segment of the SynerG coil, especially the SR type, was a highly probable cause of these technical problems. Our clinical experience showed a high incidence of technical problems, and in vitro observations suggested that the new GDC designs could be responsible for them. For safe aneurysm treatment, details of embolization techniques should be modified.American Journal of Neuroradiology 10/2002; 23(8):1269-75. · 2.93 Impact Factor -
Article: Intraarterially administered abciximab as an adjuvant thrombolytic therapy: report of three cases.
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ABSTRACT: The intravenous administration of abciximab can be used as an adjuvant therapy to facilitate thrombolysis for acute cerebrovascular occlusion. However, to our knowledge, the intraaterial administration of abciximab has not been reported. We recently treated three patients with acute thrombosis of the cerebral arteries by using an intraarterial infusion of urokinase and abciximab. Even with small doses, we achieved rapid and complete recanalization without complications. We believe that the intraarterial infusion of abciximab may be promising for effective and safe recanalization of acute thrombotic occlusion of cerebral arteries.American Journal of Neuroradiology 04/2002; 23(3):447-51. · 2.93 Impact Factor
Top co-authors
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Institutions
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2008–2012
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Konkuk University
- • Department of Neurosurgery
- • Department of Radiology
Seoul, Seoul, South Korea
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2011
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Konkuk University Medical Center
Changnyeong, South Gyeongsang, South Korea
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